1. Bone Cancer

2. Development of Bone Cancer
Advancing age and a previous history of cancer are the two most important risk factors for cancer
Primary bone cancer is uncommon; however, the skeleton is the most common organ affected by metastatic cancer.
Primary cancers of the breast, prostate, thyroid, lung, and kidney commonly metastasize to the bone.
Cancer is more likely to metastasize to the vertebrae, pelvis, ribs, skull, proximal femur, sternum, or cervical spine.
Bone pain in the lumbar spine or proximal femur can refer pain to the knee.

3. Common Risk Factors Age over 50 years
Ethnicity: racial minorities and ethnic groups are at an elevated risk
Family history
Environment and lifestyle

4. Presentation of Bone Cancer
Deep pain
Poorly localized
Pain increases with activity
Pain description: burning, aching, stabbing
Pain is cyclic and progressive until it becomes constant
Decreased tolerance to weight bearing
Antalgic patterns.
Bone pain does not respond well to physical agents
Soft tissue swelling
Pathologic fractures
Hypercalcemia
Back or rib pain

5. Additional Signs and Symptoms
Unexplained changes in appetite
Unexplained weight gain or loss of 10% of total body weight within the last 4 weeks
Proximal muscle weakness
if the nerves are compressed
Change in two or more deep tendon reflexes
Palpable lump or mass
Pain present at night, unrelieved by change in position

6. Tests to Differentiate
Heel strike test
Pain reproduced is indicative of a fracture
Fractures can also be associated with tumors
Pain that subsides with salicylates is characteristic of an osteoid osteoma
Osteoid osteoma is a benign
osteoblastic tumor that commonly
occurs in the diaphysis of long bones
Occurs usually between ages 7 to 25

7. Recommendation
Refer to primary care physician for further testing

8. Reference
Siegenthaler, Walter Siegenthaler’s Differential Diagnosis in Internal Medicine: From Symptom to Diagnosis. Georg Thieme Verlag. Stuttgart, Germany pages.